From Dharavi to Sao Paulo’s favelas, a Covid-19 response must engage the communities that live there

In a shining city filled with nameless people, somewhere between the concrete structures in land-starved Mumbai, is Dharavi. Some call it a slum. I prefer to call it India’s largest informal settlement-city.

With several hundred Covid-19 cases recently detected and numerous deaths in Dharavi, India’s most romanticised informal settlement is in the news again, with news reports referring to it as a “ticking time bomb”.

The case of Dharavi is a reminder of the millions of migrants – not just in India, but globally – who move to cities in the hope of better lives but live in subhuman conditions. We celebrate their aspiration, never their well-being.

Sometimes, 10 people stay within 10-by-10 rooms with little ventilation. These are tinderboxes for diseases like tuberculosis or Covid-19. The bathrooms are shared by a few 100; as is the water. In fact, drinking water is a precious commodity that comes at considerable cost.

From Mumbai to Mexico City, Karachi to Cape Town, Cairo to Sao Paula – “Dharavis” exist everywhere. Their existence epitomises society’s collective failure and calls out our chequered and unequal growth story.

Economic powerhouses

Telling those who live in these settlements about staying at home, physical distancing, eating well, and handwashing is not just farcical – it is downright cruel. In India, the middle class and its self-serving media often discuss settlements like Dharavi and their residents as a problem. Yet, no one wishes them away because the residents of such settlements support them, working in their offices, factories and homes.

These settlements are economic powerhouses where embroiderers, leather workers, metal workers, waiting staff, drivers, sex workers, and hundreds of other trades flourish, supported by poor economic migrants. In India, it is a parallel economy which supports the middle class in its comfort and keeps the government free of taking responsibility for them.

The many Dharavis throughout India and the globe are in perpetual health crises. Depending on your location, anything and everything – be it tuberculosis, malaria, dengue, malnutrition and even tooth decay – exists at an epic scale.

What do we offer residents of these settlements in a health crisis? Poor pay, no job guarantee, no paid leave or health insurance; A choice between overburdened, underfunded public health systems or expensive private care that breeds debt.

Crafting a response

The fallacy of our approach is dawning upon us as this virus indiscriminately disrupts livelihoods at a global scale. So what would a comprehensive response be?

Containment strategies are useful but let’s also empathetically understand the problems of the residents. They need access to food, medicines, water and information. These are critical if we want to fight the virus. Unplanned lockdowns backfire here as people become anxious, fearful and desperate.

Contact tracing is critical but a bigger aspect is building trust and connectedness. Engaging communities in this response makes contact tracing more effective. Communities that live here are well-networked and need to be informed and engaged. We need to work with the multiple actors already involved in these areas – non-government organisations, community groups, and religious organisations – to spread information and deliver services.

Empowering people with information, building trust and improving social cohesion is crucial. We must avoid gaps in service delivery, where the population density is high and where the virus – and hunger – affects large numbers.

Perhaps, most importantly, we need to think about how, going forward, we can change conditions here because these settlements, vibrant as they may be, are an assault on human dignity and health.

I still remember the first time I went to Dharavi as a young researcher to record the narratives of Mumbai’s sex workers – the bravest women I have ever known. Cramped in small, one-room, makeshift settlements and struggling with abuse children. They were courageous and resourceful, fighting HIV.

In a subsequent visit, I spent a rainy day with Owais, an economic migrant from Uttar Pradesh who was HIV-positive and had defeated an incurable form of drug-resistant tuberculosis. Would he go back home? I asked him. As incessant rain flooded the narrow lane, where he lived in a small room, he smiled and said “I like it here. This is home.”

It is residents like these, anywhere, who can lead the fight against Covid-19 – if only we engage them.

The many Dharavis aren’t the problem – our approach to human health and development is. Perhaps, we would do better if we step back from the romance or vilification of these settlements and see them for what they are. Not just sites for tragic stories, but a place many people call home.